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Jul 4

Testosterone May Increase COVID-19 Complication Risks – Everyday Health

Testosterone Comments Off on Testosterone May Increase COVID-19 Complication Risks – Everyday Health

It appears that the coronavirus disease 2019 (COVID-19) hits men much harder than women. According to astudy published in April 2020 inFrontiers in Public Health, males are dying at twice the rate of females (regardless of age) when they contract the virus. The million-dollar question is: Why? An analysis of studies, published in Andrology in June 2020, proposes three ideas about why the male sex hormone, testosterone, may be the problem.

Studies have shown that testosterone can regulate production and activity of the protein receptor ACE2, which mediates entry of the virus into cells, and TMPRSS2, a co-receptor that activates the virus.

Research showed years ago that these proteins functioned in the same manner to facilitate the entry of SARS-CoV-1 into cells; current COVID-19 research is finding that these same proteins function the same ways with respect to SARS-CoV-2, explains Jon E. Levine, PhD, a professor of neuroscience at the University of Wisconsin and the director of the Wisconsin National Primate Research Center in Madison. Dr. Levine was not involved in the study analysis.

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When men are critically ill, their testosterone levels dramatically drop. Normal levels of testosterone are required to protect the functioning of cells in the lining of blood vessels (preventing blood clotting) and may protect against a defective immune response. Having low testosterone levels because you are critically ill may impair your ability to clear the virus and promotes systemic inflammation, says Dr. Levine.

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Men tend to develop obesity in abdominal versus subcutaneous adipose tissue under the influence of androgenic hormones, such as testosterone. That abdominal, or belly fat, tissue generates more inflammatory cytokines, small proteins that are important in cell signaling. This is why males tend to have higher rates of diabetes, cardiovascular disease, atherosclerosis, metabolic syndrome, insulin resistance, and respiratory disease(asthma,bronchitis,emphysema, or chronic obstructive pulmonary disease). If you're a male with preexisting obesity and metabolic disease, when you get this virus in the lungs, you may be more vulnerable because you already have preexisting peripheral inflammation, Levine explains.

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Welcome to the confusing and complicated world of hormones,Meredith W. Reiches, PhD, the assistant director of the GenderSci Lab at Harvard Universityin Boston, says in an email message. Hormones can indeed have different effects in different doses, at different receptor sites, and in different endocrine contexts. For instance, estradiol, a form of estrogen, promotes bone growth during puberty when it binds with one kind of receptor, but, at a higher concentration, it causes the epiphyses [end part of a long bone] to fuse, ending bone growth, when it binds to a receptor that is only active at higher concentrations. So, while the theories in the Andrology study are in some ways difficult to reconcile, the effect of testosterone on the course of the disease could actually be different in different contexts. Dr. Reiches was also not part of the study analysis.

Dr. Reiches, who is also an assistant professor of anthropology at the University of Massachusetts in Boston, explains that the different effects of testosterone are a reason why "testosterone probably isnt a panacea explanation for sex differences in outcomes.

She and her group at the GenderSci Lab believe that while it might be the case that sex-linked biological traits such as hormones contribute to the ways bodies respond to COVID-19, emerging case-fatality rate data from COVID-19 suggests that sex-linked biology is unlikely to be the primary driver of differences in outcomes between men and women. Among U.S. states and territories, as of June 22, 2020, 53 percent of reported deaths in Delaware are women, while in California, 56 percent are men. The team would have expected a more robust consistency in case-fatality rates by sex if, for instance, testosterone-linked differences in ACE2 expression and activity were the main determinant of how men and women respond to COVID-19.

Instead, Reiches reports in the same email message, Observed variation suggests that, as with earlier coronavirus infections like SARS and MERS and prior pandemics like the 1918 Spanish flu, many social factors affect who is exposed to a virus, the viral dose of the exposure, their age and health at the time of infection, how likely they are to seek care, and how responsive and effective medical intervention might be.

"Therefore, while we dont rule out contributions from sex-linked biology, we advocate for data collection, disaggregation, and analysis of factors where public health, policy, and clinical workers can help make changes say, in improving working and living conditions of people in poverty and people in caregiving roles, or investigating and treating causes of comorbidities in populations experiencing chronic and endemic racism, says Reiches.

We have much to learn about how SARS-CoV-2 functions in the body, Reiches concludes. When it comes to identifying urgent targets for intervention, however, our research group argues, based on the available data and on precedent from similar pandemics, that attention to social factors will explain much of the variation in outcomes.

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Testosterone May Increase COVID-19 Complication Risks - Everyday Health

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